By Ian Ségal
February 18, 2025
(Image Source: Cardiovascular Institute of the South, 2024)
Introduction
Heart failure (HF) is a chronic and progressive condition characterized by the heart’s inability to pump sufficient blood to meet the body’s metabolic demands. This syndrome can arise from various structural or functional cardiac abnormalities, leading to reduced cardiac output and elevated intracardiac pressures, manifesting as symptoms such as breathlessness, fatigue, and fluid retention (Houck et al., 2020; Sampson, 2022). The complexity of heart failure is underscored by its multifactorial etiology, which includes coronary artery disease, hypertension, diabetes mellitus, and valvular heart disease, among others (Dhanorkar & Rajabhau, 2020; Sarkari et al., 2020; Diaconu, 2019).
The significance of studying heart failure is amplified by its increasing prevalence globally, with estimates suggesting that approximately 26 million people are affected by this condition (Guo et al., 2022). The burden of heart failure on healthcare systems is substantial, contributing to high hospitalization and mortality rates, which necessitates a comprehensive understanding of its mechanisms, prevention strategies, and management approaches (Guo et al., 2022; Padi et al., 2022). Furthermore, the impact of heart failure extends beyond physical health, affecting patients’ quality of life and psychological well-being, particularly among diverse adult demographics (Niaz et al., 2021; Nyaga et al., 2018).
The objective of this research is to explore the disease mechanisms underlying heart failure, identify effective prevention strategies—including pharmaceutical interventions and medical devices such as cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM) therapy—and analyze management approaches tailored to various adult demographics, including age, gender, ethnicity, and socioeconomic status (Guo et al., 2022; Padi et al., 2022; Nyaga et al., 2018).
Disease Mechanisms
The pathophysiology of heart failure is complex, involving a combination of neurohormonal activation, myocardial remodeling, and systemic responses to decreased cardiac output (Tanai & Frantz, 2015). Neurohormonal systems, particularly the renin-angiotensin-aldosterone system (RAAS), play a critical role in the progression of heart failure by promoting vasoconstriction and fluid retention, which exacerbate the workload on the heart (Tanai & Frantz, 2015). Additionally, inflammation and oxidative stress are increasingly recognized as important contributors to myocardial injury and dysfunction in heart failure (Tanai & Frantz, 2015).
(Image Source: Gallo & Savoia, 2024)
Recent studies have highlighted the significance of genetic factors in heart failure, with heritability estimates suggesting a genetic contribution of 26-34% to the development of this condition (Arvanitis et al., 2019). Furthermore, the interaction between genetic predisposition and environmental factors, such as obesity and diabetes, complicates understanding heart failure mechanisms (Inoue et al., 2016).
The role of comorbidities in heart failure is also crucial, as conditions such as chronic obstructive pulmonary disease (COPD) and diabetes significantly impact the prognosis and management of heart failure patients (Cosentino et al., 2018; Koike et al., 2016). For instance, the coexistence of COPD and heart failure has been shown to worsen clinical outcomes, highlighting the need for integrated management strategies that address multiple health issues simultaneously (Cosentino et al., 2018; Koike et al., 2016).
Prevention Strategies
Preventing heart failure involves addressing modifiable risk factors and implementing early intervention strategies. Key risk factors include hypertension, diabetes, obesity, and coronary artery disease, which can be managed through lifestyle modifications and pharmacological treatments (Dhanorkar & Rajabhau, 2020; Sarkari et al., 2020; Diaconu, 2019). For instance, lifestyle changes such as increased physical activity, dietary modifications, and smoking cessation have been shown to reduce the incidence of heart failure (Satoh et al., 2015).
(Image Source: Ted Rogers Centre for Heart Research, 2022)
Pharmacological interventions play a pivotal role in heart failure prevention, particularly in high-risk populations. Medications such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists have demonstrated efficacy in reducing the risk of heart failure in patients with underlying cardiovascular conditions (Sano, 2020; , Das et al., 2021). Additionally, sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as a promising class of medications, showing benefits not only in diabetes management but also in heart failure prevention (Sano, 2020; Das et al., 2021).
Medical device technologies, such as CRT and CCM therapy, represent innovative approaches to heart failure management. CRT has been shown to improve cardiac function and reduce symptoms in patients with heart failure and electrical dyssynchrony (Verbrugge et al., 2012). Similarly, CCM therapy aims to enhance cardiac contractility through non-invasive stimulation, providing an alternative for patients who may not be candidates for traditional pharmacological therapies (Verbrugge et al., 2012).
Treatment Approaches
The treatment of heart failure is multifaceted, encompassing pharmacological, interventional, and lifestyle strategies. Pharmacological management typically involves diuretics, ACE inhibitors, beta-blockers, and aldosterone antagonists, which collectively aim to alleviate symptoms, improve quality of life, and reduce mortality (Sampson, 2022). Recent advancements in pharmacotherapy, including the introduction of SGLT2 inhibitors, have expanded the therapeutic options available for heart failure patients, particularly those with reduced ejection fraction (Sano, 2020; , Das et al., 2021).
(Image Source: Meril Life, 2020)
Interventional strategies, such as the use of left ventricular assist devices (LVADs) and heart transplantation, are reserved for patients with advanced heart failure who do not respond adequately to medical therapy (Leff & Shore‐Lesserson, 2010; , Ayub‐Ferreira & Pêgo‐Fernandes, 2022). LVADs have been shown to improve survival and quality of life in patients with end-stage heart failure, serving as both a bridge to transplantation and destination therapy (Leff & Shore‐Lesserson, 2010; Ayub‐Ferreira & Pêgo‐Fernandes, 2022).
In addition to traditional treatment modalities, emerging therapies such as gene therapy and regenerative medicine hold promise for the future of heart failure management. These innovative approaches aim to repair or regenerate damaged myocardial tissue, potentially reversing the course of heart failure (Tanai & Frantz, 2015).
Management Across Diverse Adult Demographics
Heart failure management strategies must be tailored to the unique needs of diverse adult demographics, including variations in age, gender, ethnicity, and socioeconomic status. Age-related factors significantly influence the presentation and management of heart failure, with older adults often experiencing atypical symptoms and a higher burden of comorbidities (Matsuo, 2020).
Gender differences also play a critical role in heart failure, with women exhibiting distinct clinical characteristics and responses to treatment compared to men. For instance, women are more likely to develop heart failure with preserved ejection fraction (HFpEF), which presents unique challenges in management (Poliakova & Шарапова, 2024; Bain, 2018). Moreover, women often experience a delay in diagnosis and treatment, underscoring the need for gender-sensitive approaches in heart failure care (Poliakova & Шарапова, 2024; Bain, 2018).
Ethnic disparities in heart failure prevalence and outcomes have been documented, with specific populations, such as African Americans, experiencing a higher burden of heart failure and worse outcomes compared to their white counterparts (Niaz et al., 2021; Nyaga et al., 2018). Socioeconomic factors, including access to healthcare and health literacy, further complicate the management of heart failure in diverse populations, necessitating targeted interventions to address these disparities (Niaz et al., 2021; Nyaga et al., 2018).
(Image Source: Ilonze & Mazimba, 2024)
Public Health Implications
Heart failure poses a significant public health challenge due to its complex causes and the diverse management strategies required. To enhance outcomes for heart failure patients, it is crucial to understand the underlying mechanisms of the condition, implement effective prevention strategies, and customize treatment approaches for various adult populations. Ongoing research is vital, as it will facilitate the integration of innovative therapies and emphasize personalized care, which is essential in tackling the increasing global burden of heart failure.
Background
Heart failure (HF) is a complex clinical syndrome characterized by the heart’s inability to pump sufficient blood to meet the body’s needs. It is a significant public health issue, with increasing prevalence and incidence rates globally. Epidemiological studies indicate that HF affects approximately 1-2% of the adult population and over 10% of the elderly in developed countries, with the burden expected to rise due to aging populations and increasing prevalence of risk factors such as hypertension, diabetes, and obesity (He et al., 2019; Khatibzadeh et al., 2013). The American Heart Association reports that nearly 6.5 million adults in the United States are living with HF, and this number is projected to increase as the population ages and the prevalence of associated comorbidities rises (Campbell et al., 2015; Akintoye et al., 2022).
The epidemiology of heart failure reveals significant variations in prevalence and incidence across different populations and demographics. For instance, studies have shown that older adults are at a higher risk for developing HF, with age being a critical determinant of outcomes (Chen et al., 2019; Li, 2024). Furthermore, the incidence of HF is notably higher in individuals with comorbid conditions such as chronic kidney disease and diabetes (Tan et al., 2023). A cohort study found that patients with psoriatic disease exhibited a higher incidence of HF events compared to the general population, highlighting the influence of specific health conditions on HF risk (Koppikar et al., 2022).
(Image Source: Bozkurt et al., 2023)
Risk factors for heart failure are multifaceted and can be categorized into modifiable and non-modifiable factors. Common modifiable risk factors include hypertension, diabetes, obesity, and a sedentary lifestyle, which have been consistently linked to the development of HF (Avery et al., 2012; Rodeheffer, 2011). Hypertension is particularly significant, as it can lead to left ventricular hypertrophy and subsequent heart failure (Yelwanti & Desai, 2016). Diabetes mellitus is another critical risk factor, with studies indicating that individuals with diabetes have a higher likelihood of developing HF due to associated metabolic dysregulations (Verma et al., 2019; Melle et al., 2010). Obesity, often mediated by hypertension, has also been identified as a major risk factor, with evidence suggesting that weight management can significantly reduce the risk of HF (Zhang et al., 2023; Odeyemi et al., 2022).
Demographic variations in risk factors are evident, with studies showing that men are generally at a higher risk for HF compared to women, although women tend to develop HF at an older age (Ullah et al., 2021; Ahmad et al., 2016). Additionally, psychosocial factors such as stress and depression have been associated with an increased risk of HF, particularly in vulnerable populations (Ogilvie et al., 2016). The interplay of these risk factors is complex, as they often coexist and exacerbate one another, leading to a cumulative effect on heart health (Campbell et al., 2015; Avery et al., 2012).
The pathophysiology of heart failure involves a series of biological mechanisms that ultimately lead to the heart’s inability to function effectively. The condition can be classified into two main types: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). In HFrEF, the heart muscle is weakened and cannot pump blood efficiently, while in HFpEF, the heart muscle is stiff and does not fill properly (Lerman et al., 2019; Soysaler et al., 2023). Both types are associated with neurohormonal activation, including the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, which contribute to fluid retention, increased blood pressure, and further cardiac remodeling (Campbell et al., 2015; Lerman et al., 2019).
The biological mechanisms underlying heart failure are complex and involve structural and functional changes in the heart. For instance, left ventricular hypertrophy due to chronic pressure overload from hypertension can lead to diastolic dysfunction and, eventually, heart failure (Yelwanti & Desai, 2016). Additionally, myocardial ischemia, often resulting from coronary artery disease, can lead to myocardial infarction and subsequent heart failure (Campbell et al., 2015; Akintoye et al., 2022). The presence of comorbidities such as diabetes and chronic kidney disease further complicates the pathophysiology, as they can lead to additional stress on the cardiovascular system and contribute to adverse outcomes (Tan et al., 2023).
Disease Mechanisms
Heart failure (HF) can be classified into two primary types based on the ejection fraction (EF): heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). HFpEF is defined as heart failure where the EF is greater than or equal to 50%, while HFrEF is characterized by an EF of less than 40% (Xiao-ming et al., 2024). The underlying mechanisms of these two types of heart failure differ significantly. HFrEF is often associated with ischemic heart disease, myocardial infarction, and dilated cardiomyopathy, leading to a reduction in the heart’s pumping ability due to structural damage (Xiao-ming et al., 2024). In contrast, HFpEF is frequently linked to conditions such as hypertension, obesity, and diabetes, which lead to diastolic dysfunction, where the heart is unable to relax properly during diastole (Jain et al., 2018).
(Image Source: The Heart Failure Policy Network, n.d.)
The demographic variations in heart failure prevalence and mechanisms are significant, particularly when comparing older and younger adults, as well as men and women. Older adults are more likely to develop HFpEF due to age-related changes in cardiac structure and function, as well as the accumulation of comorbidities such as hypertension and diabetes (Coats, 2019). In contrast, younger adults are more frequently diagnosed with HFrEF, often due to congenital heart defects or lifestyle factors such as substance abuse (Snow et al., 2019). Gender differences also play a crucial role in heart failure; men are more likely to develop HFrEF, while women tend to present with HFpEF (Meyer et al., 2013). This disparity is believed to stem from hormonal differences, particularly the protective effects of estrogen in premenopausal women, which may contribute to the lower incidence of cardiovascular diseases in this group (Meyer et al., 2013).
(Data Table Source: The Heart Failure Policy Network, n.d.)
The etiology of heart failure also exhibits geographic and demographic variations. For instance, studies have shown that African Americans have a higher prevalence of HFrEF compared to Caucasians, which may be attributed to higher rates of hypertension and diabetes in this population (Owusu, 2013). Furthermore, the concept of a “Heart Failure Belt” in the Southeastern United States highlights regional disparities in heart failure mortality, suggesting that socioeconomic factors, access to healthcare, and lifestyle choices contribute to these differences (Mujib et al., 2011). Additionally, the prevalence of heart failure is increasing globally, with significant variations noted across different countries and regions, influenced by factors such as healthcare infrastructure, public health policies, and cultural attitudes towards health (Entezari‐Maleki, 2023).
The pathophysiological mechanisms underlying heart failure are multifaceted and influenced by a range of factors, including genetics, lifestyle, and comorbid conditions. Genetic predispositions can play a significant role in the development of heart failure, particularly in familial cases where inherited cardiomyopathies are present (O’Donnell et al., 2018). Lifestyle factors, such as physical inactivity, poor diet, and smoking, are modifiable risk factors that can exacerbate heart failure symptoms and progression (Younis, 2015). Moreover, the presence of comorbidities such as chronic kidney disease, diabetes, and obesity can complicate the management of heart failure and contribute to worse outcomes (Jeele et al., 2022).
Prevention Strategies
Heart failure (HF) is a pressing public health issue that requires effective prevention strategies to reduce its incidence and enhance patient outcomes. Key prevention approaches include lifestyle modifications, screening and early detection, and cultural considerations. Each of these strategies is vital in lowering the risk of heart failure and improving the quality of life for at-risk individuals. By focusing on these areas, healthcare providers and public health prevention scientists can make significant strides in combating heart failure and promoting healthier communities.
(Image Source: Virginia Department of Health, n.d.)
Lifestyle Modifications
Lifestyle modifications are foundational in preventing heart failure. Key components include dietary changes, regular physical activity, and smoking cessation. A heart-healthy diet, rich in fruits, vegetables, whole grains, and lean proteins, has been shown to lower the risk of cardiovascular diseases, including heart failure. For instance, adherence to the Mediterranean diet is associated with a reduced incidence of heart failure, particularly among older adults (Marinescu et al., 2023). Additionally, regular physical activity is essential for maintaining cardiovascular health. Exercise improves heart function, reduces blood pressure, and aids in weight management, which is critical in preventing heart failure (Ray, 2024).
Moreover, smoking cessation is a vital aspect of lifestyle modification. Smoking is a well-established risk factor for cardiovascular diseases, including heart failure. Research demonstrates that individuals who quit smoking substantially reduce their risk of developing heart failure compared to those who continue smoking (Chruscinski et al., 2016). Furthermore, psychosocial factors such as depression can exacerbate heart failure outcomes, highlighting the importance of addressing mental health alongside lifestyle changes (Solomou et al., 2016).
Incorporating these lifestyle modifications into daily routines can lead to substantial improvements in cardiovascular health and a decrease in heart failure incidence. Public health initiatives promoting these changes are essential for reducing the population’s heart failure burden.
Screening and Early Detection
Screening and early detection are critical in identifying individuals at risk for heart failure before symptoms manifest. Regular health screenings, particularly for high-risk populations, can facilitate early intervention and management of risk factors. For instance, biomarkers such as B-type natriuretic peptide (BNP) have been shown to be effective in screening for heart failure, particularly in geriatric populations (Marinescu, 2023). Elevated levels of BNP can indicate heart dysfunction, prompting further evaluation and timely intervention.
Additionally, advanced screening techniques, such as echocardiography and electrocardiograms, can detect early signs of heart failure, such as left ventricular hypertrophy and diastolic dysfunction (Kokubo et al., 2022; Gohar et al., 2019). These methods enable healthcare providers to implement preventive measures, such as lifestyle modifications and pharmacological interventions, before the onset of symptomatic heart failure.
Community-based screening programs have demonstrated success in identifying asymptomatic individuals at risk for heart failure. For example, the SCREEN-HF study highlighted the effectiveness of workplace screenings in detecting chronic heart failure among employees, emphasizing the need for accessible screening options in various settings (Boffa et al., 2017).
Moreover, integrating technology in screening processes, such as telemedicine and artificial intelligence, can enhance early detection efforts. These innovations allow for continuous monitoring of patient’s health status, enabling timely interventions that can prevent the progression of heart failure (Urien et al., 2024; Brooksbank & Albert, 2023).
Cultural Considerations
Cultural beliefs and practices significantly influence the effectiveness of heart failure prevention strategies. Understanding the cultural context of different demographics is essential for tailoring interventions that resonate with specific populations. For instance, dietary preferences and physical activity levels can vary widely across cultures, impacting the adoption of lifestyle modifications (Alemayehu et al., 2022).
In some cultures, traditional diets may be high in sodium and unhealthy fats, increasing the risk of hypertension and heart failure. Public health campaigns incorporating culturally relevant dietary recommendations can enhance the acceptance and effectiveness of lifestyle changes (Cooper et al., 2015). Additionally, cultural attitudes toward healthcare and preventive measures can affect individuals’ willingness to participate in screening programs.
(Image Source: Soto, 2019)
For example, certain communities may be skeptical toward medical interventions or prefer traditional healing practices. Engaging community leaders and utilizing culturally sensitive communication strategies can improve participation in screening and prevention programs (Okello et al., 2013).
Furthermore, addressing social determinants of health, such as access to healthcare, education, and socioeconomic status, is crucial in designing effective prevention strategies. Tailoring interventions to meet the unique needs of diverse populations can lead to better health outcomes and reduced disparities in heart failure incidence (Dahy et al., 2020).
Summary of Prevention Strategies
Effective heart failure prevention strategies encompass lifestyle modifications, screening and early detection, and cultural considerations. By promoting healthy lifestyles, implementing regular screening practices, and acknowledging cultural influences, healthcare providers can significantly reduce the risk of heart failure. Future efforts should focus on integrating these strategies into comprehensive public health initiatives to improve cardiovascular health outcomes across diverse populations.
Management Approaches
The management of heart failure encompasses a variety of pharmacological and non-pharmacological approaches, including lifestyle modifications, device therapies, and addressing disparities in access to care. This comprehensive overview synthesizes current management strategies for heart failure, focusing on pharmacological treatments, non-pharmacological interventions, including medical devices, and the impact of access to care on treatment outcomes.
Pharmacological Treatments
Pharmacological management of heart failure primarily involves the use of several classes of medications that have been shown to improve symptoms, reduce hospitalizations, and enhance survival rates. The cornerstone of heart failure treatment includes angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs). ACE inhibitors, such as lisinopril and ramipril, have been extensively studied and are known to reduce morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) (Stoica et al., 2020; Uhl et al., 2015). Beta-blockers, including carvedilol and metoprolol succinate, also improve left ventricular function and reduce the risk of sudden cardiac death (Roller et al., 2018; Medert et al., 2021).
(Image Source: Roland, 2024)
Recent studies have highlighted the importance of tailoring pharmacological treatments to specific populations, including older adults and those with comorbid conditions. For instance, beta-blockers’ efficacy may vary based on age and other health issues, necessitating careful dose adjustments and monitoring (LaRocca et al., 2010; Dulai et al., 2020). Additionally, newer agents such as sacubitril/valsartan, a combination of an angiotensin receptor blocker and a neprilysin inhibitor, have shown significant benefits in reducing cardiovascular death and heart failure hospitalizations compared to traditional therapies (Chaturvedi et al., 2015; Shen et al., 2015). The introduction of sodium-glucose cotransporter 2 (SGLT2) inhibitors has also emerged as a promising option, demonstrating favorable outcomes in patients with heart failure, regardless of diabetes status (Loaiza et al., 2024; Blinova et al., 2023).
Non-Pharmacological and Medical Device Interventions
In addition to pharmacological treatments, non-pharmacological interventions are crucial in managing heart failure. Lifestyle modifications, including dietary changes, regular physical activity, and smoking cessation, can significantly improve patient outcomes. Education on self-management strategies is essential for empowering patients to take an active role in their care (Al‐Ghamdi et al., 2017; Rasouli & Stainier, 2017).
Medical device therapies, such as cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM), have gained prominence in managing heart failure. CRT is particularly beneficial for patients with HFrEF and a prolonged QRS duration, as it improves ventricular synchrony and enhances cardiac output (Shettigar et al., 2016; Sasaki et al., 2018). Studies have shown that CRT can lead to significant improvements in functional capacity and quality of life, as well as reductions in hospitalizations (Wang et al., 2013; Mun et al., 2014).
CCM therapy, a newer intervention, involves the application of non-excitatory electrical impulses during the cardiac refractory period, which enhances myocardial contractility without increasing myocardial oxygen demand (Pardon et al., 2024; Dvornikov et al., 2014). Clinical trials have demonstrated that CCM can improve exercise capacity and quality of life in patients with symptomatic heart failure who are not candidates for CRT (Wadthaisong et al., 2019; Fang et al., 2024). The Optimizer Smart device, which delivers CCM therapy, has been shown to be effective in various patient populations, including those with ischemic and non-ischemic cardiomyopathy (Wojtaszczyk et al., 2024; Yang et al., 2019).
Access to Care
Access to healthcare services is a critical determinant of health outcomes in heart failure management. Disparities in access can significantly affect treatment adherence, patient education, and overall management outcomes. Studies have shown that socioeconomic factors, geographic location, and insurance coverage play substantial roles in determining access to necessary therapies, including advanced medical devices and specialized care (Nichols et al., 2010; Traister et al., 2014).
For instance, patients from lower socioeconomic backgrounds often face barriers to accessing high-quality care, leading to worse outcomes compared to their more affluent counterparts (Liu et al., 2018; Mizutani et al., 2016). Furthermore, racial and ethnic disparities have been documented in the utilization of heart failure therapies, with minority populations often receiving suboptimal care (Feaster et al., 2021; Manganelli et al., 2021). Addressing these disparities requires targeted interventions, such as community outreach programs, improved insurance coverage, and policies to increase healthcare access for underserved populations (Matteucci et al., 2022; Masarone et al., 2022).
Management Approach Concluding Thoughts
The management of heart failure is multifaceted, involving a combination of pharmacological treatments, lifestyle modifications, and advanced medical device therapies. Each approach is vital in improving patient outcomes and quality of life. However, disparities in access to care remain a significant challenge that must be addressed to ensure equitable treatment for all patients. Future research should focus on optimizing treatment strategies across diverse populations and enhancing access to innovative therapies for heart failure management.
Case Studies
This synthesis explores case studies that highlight the differences in heart failure management and outcomes among various demographic groups, with a particular focus on African American versus Caucasian populations, as well as urban versus rural settings. It also presents success stories of effective community-based interventions tailored to specific demographics.
(Image Source: Griffith, 2023)
Comparative Analysis of Heart Failure Management
Heart failure management varies considerably across demographic groups, influenced by socioeconomic status, access to healthcare, and cultural factors. For instance, studies have shown that African American patients with heart failure often experience worse outcomes compared to their Caucasian counterparts. This disparity can be attributed to several factors, including differences in access to care, treatment adherence, and the prevalence of comorbid conditions such as hypertension and diabetes, which are more prevalent in African American populations (Patel et al., 2022; Son et al., 2020). Furthermore, the impact of social determinants of health, such as income and education level, plays a critical role in these disparities. Research indicates that lower socioeconomic status is associated with higher rates of hospital readmissions and poorer health outcomes in heart failure patients (Smith et al., 2012; Herold et al., 2018).
In urban settings, heart failure management is often complicated by factors such as overcrowded healthcare facilities and limited access to specialized care. Urban patients may face barriers such as transportation issues and lack of health insurance, which can hinder their ability to attend follow-up appointments and adhere to treatment regimens (Klaiman et al., 2023). Conversely, rural populations may experience challenges related to the availability of healthcare resources, including fewer specialized heart failure clinics and longer travel times to receive care. A study found that rural patients are less likely to receive guideline-directed medical therapy than their urban counterparts, leading to worse outcomes (Xiuzhen et al., 2022).
Moreover, the effectiveness of transitional care interventions has been shown to differ based on demographic factors. For example, a systematic review indicated that transitional care programs that include disease education and personalized nursing plans significantly improve outcomes for heart failure patients, but these benefits may not be uniformly experienced across different demographic groups (Xiuzhen et al., 2022; DeVore et al., 2021). The need for culturally competent care is essential in addressing these disparities, as interventions tailored to the specific needs of diverse populations can lead to improved adherence and health outcomes (Sarhadi et al., 2024).
Success Stories of Community-Based Interventions
Community-based interventions have emerged as effective strategies for improving heart failure management, particularly among underserved populations. One notable success story is the implementation of a text messaging intervention aimed at enhancing self-management among heart failure patients in a predominantly Black and African American community. This intervention significantly improved patients’ self-care behaviors and reduced hospital readmissions, demonstrating the potential of technology to bridge gaps in care (Nundy et al., 2013). Using culturally relevant educational materials and community health workers to facilitate engagement has proven effective in increasing treatment adherence and improving health outcomes in this demographic (Sarhadi et al., 2024).
Another successful intervention involved a nurse-led heart failure education program tailored for elderly patients in rural settings. This program focused on enhancing patients’ understanding of their condition and the importance of medication adherence. The results showed a marked reduction in hospital readmissions and improved quality of life among participants (Oliver et al., 2022). Such community-based programs highlight the importance of addressing the unique challenges different demographic groups face and the potential for tailored interventions to yield positive outcomes.
Additionally, a study examining the effects of a home-based palliative care program for elderly heart failure patients found significant improvements in quality of life and symptom management. This program emphasized the importance of family involvement and support, which is particularly crucial in communities where familial ties are strong (Khajehpoor et al., 2023). The success of these interventions underscores the need for healthcare systems to adopt a holistic approach that considers the social and emotional aspects of heart failure management.
Cardiac Contractility Modulation — The Optimizer Smart Mini Device
Cardiac contractility modulation (CCM) therapy, through the use of the Optimizer Smart Mini device produced by Impulse Dynamics, represents a significant advancement in the management of heart failure (HF), specifically for patients with reduced left ventricular ejection fraction (LVEF). This therapy is particularly relevant for patients who are not candidates for traditional therapies such as cardiac resynchronization therapy (CRT) or those who have not responded adequately to optimal medical therapy (OMT) (Roller et al., 2018; Mando et al., 2019; Ţînţ et al., 2019). The CCM mechanism involves applying non-excitatory electrical impulses during the absolute refractory period of the cardiac cycle, which enhances myocardial contractility without increasing myocardial oxygen demand (Winter et al., 2011; Mohapatra & James, 2023).
Clinical studies have demonstrated the efficacy of CCM therapy in improving exercise tolerance, quality of life, and overall cardiac function in patients with heart failure. For instance, a systematic review and meta-analysis indicated that CCM therapy significantly enhances left ventricular contractility and exercise capacity in patients with heart failure and narrow QRS complexes (Mando et al., 2019; Ţînţ et al., 2019). In a multi-center trial involving 17 patients, significant improvements were observed in functional parameters such as peak oxygen uptake (VO2) and LVEF after six months of CCM therapy (Ţînţ et al., 2019). Furthermore, the FIX-HF-5C trial, which evaluated the safety and efficacy of the Optimizer system in patients with NYHA class III and IV heart failure, reported positive outcomes, including reduced hospitalizations and improved quality of life metrics (Roller et al., 2018).
The physiological basis for the benefits of CCM therapy lies in its ability to modulate calcium handling within cardiac myocytes. Studies have shown that CCM can increase intracellular calcium levels, enhancing contractile force without the adverse effects of traditional inotropic agents (Winter et al., 2011; Mohapatra & James, 2023). This is particularly important in the context of heart failure, where impaired calcium cycling is a hallmark of the disease. The modulation of calcium dynamics through CCM has been linked to improvements in myocardial energetics and reduced myocardial fibrosis, contributing to better overall cardiac function (Yang et al., 2019; Wojtaszczyk et al., 2024).
Moreover, the safety profile of CCM therapy has been a focal point in clinical evaluations. The therapy has been shown to be safe for patients with a history of heart failure, including those with atrial fibrillation, which was previously considered a contraindication for earlier generations of CCM devices (Hesselson, 2022; Narducci et al., 2023). Long-term studies have indicated that patients receiving CCM therapy experience fewer adverse events and improved survival rates compared to those receiving standard care (Haizhu et al., 2010; Manganelli et al., 2021). For example, a retrospective study found that patients who underwent CCM therapy had a lower mortality rate than predicted by the Seattle Heart Failure Model, suggesting a potential survival benefit associated with this therapy (Haizhu et al., 2010; Manganelli et al., 2021).
The economic implications of CCM therapy are also noteworthy. Research has indicated that the implementation of CCM can lead to reduced healthcare costs associated with heart failure management by decreasing hospitalization rates and improving patient outcomes (Ţînţ & Micu, 2022; Tschöpe et al., 2020). This is particularly relevant in healthcare systems facing increasing pressures from the growing prevalence of heart failure. The cost-effectiveness of CCM therapy has been compared favorably to other device-based therapies, such as CRT and implantable cardioverter-defibrillators (ICDs), highlighting its potential as a viable treatment option for a broader range of heart failure patients (Ning et al., 2014; Masarone et al., 2022).
Cardiac contractility modulation therapy, delivered by the Optimizer Smart Mini device, represents a promising therapeutic option for patients with heart failure and reduced ejection fraction. The therapy not only enhances cardiac contractility and improves patient quality of life but also demonstrates a favorable safety profile and economic viability. As ongoing research elucidates CCM’s mechanisms and long-term effects, it will likely play an increasingly important role in managing heart failure.
Case Study Concluding Thoughts
The management of heart failure is a multifaceted challenge that requires understanding the diverse needs of different demographic groups. Disparities in outcomes between African American and Caucasian populations, as well as between urban and rural settings, highlight the importance of culturally competent care and tailored interventions. Community-based programs have demonstrated success in improving self-management and health outcomes, emphasizing the need for healthcare systems to adopt innovative strategies that address the unique challenges faced by various populations. Future research should continue to explore the effectiveness of these interventions and strive to eliminate disparities in heart failure management.
Challenges and Barriers
Heart failure (HF) poses a considerable global health challenge, driven by a complex interplay of clinical, socioeconomic, and cultural factors that hinder effective prevention and treatment. These challenges create significant barriers to managing heart failure, making it essential to identify and address them to enhance patient outcomes. This discussion will focus on two critical areas: the socioeconomic factors that impact heart failure prevention and management, as well as the cultural barriers that affect treatment adherence and overall outcomes. Understanding these obstacles is vital for developing targeted interventions that can improve care for individuals at risk of or living with heart failure.
(Image Source: McClellan et al., 2019)
Socioeconomic Factors
Socioeconomic status (SES) plays a pivotal role in preventing and managing heart failure. Income, education, and insurance status are critical components of SES that significantly impact health outcomes. Individuals with lower income levels often face barriers to accessing quality healthcare services, which can lead to delayed diagnoses and inadequate management of heart failure. For instance, patients with limited financial resources may be unable to afford medications or follow-up care, resulting in poorer health outcomes and increased hospitalizations (Givertz et al., 2021; White‐Williams et al., 2022). Furthermore, studies have shown that lower income is associated with higher rates of heart failure hospitalizations, underscoring the direct correlation between financial stability and health management (Givertz et al., 2021; White‐Williams et al., 2022).
Education is another significant factor influencing heart failure management. Higher education levels are associated with better health literacy, which empowers patients to understand their condition, adhere to treatment regimens, and engage in preventive health behaviors (He et al., 2024; Hoang et al., 2023). A study highlighted that patients with higher educational attainment exhibited superior knowledge, attitudes, and practices regarding heart failure management, leading to improved health outcomes (He et al., 2024). Conversely, those with lower educational backgrounds may struggle to comprehend medical instructions, which can hinder their ability to manage their condition effectively (He et al., 2024; Hoang et al., 2023).
Insurance status further complicates the landscape of heart failure management. Patients without health insurance or those with inadequate coverage often experience barriers to accessing necessary medical care, including preventive services and medications (Givertz et al., 2021; White‐Williams et al., 2022). This lack of access can exacerbate existing health issues and contribute to the progression of heart failure. Research indicates that uninsured patients are less likely to receive guideline-directed medical therapy, which is crucial for managing heart failure effectively (Givertz et al., 2021; White‐Williams et al., 2022). The disparities in healthcare access based on insurance status highlight the need for policy interventions to improve coverage and access to care for vulnerable populations (White‐Williams et al., 2022; Ponikowski et al., 2014).
Moreover, the intersection of these socioeconomic factors creates a compounded effect on health outcomes. For instance, individuals from lower socioeconomic backgrounds not only face financial barriers but may also experience higher levels of stress and limited social support, which can negatively impact their health (Givertz et al., 2021; White‐Williams et al., 2022). The cumulative effect of low income, limited education, and inadequate insurance coverage can lead to a cycle of poor health outcomes, increased healthcare costs, and reduced quality of life for heart failure patients (Givertz et al., 2021; White‐Williams et al., 2022).
Cultural Barriers
Cultural attitudes towards healthcare significantly influence treatment adherence and outcomes in heart failure patients. Cultural beliefs and practices can shape individuals’ perceptions of illness, healthcare systems, and treatment options, often leading to disparities in care (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018). For example, some cultures may prioritize traditional healing practices over conventional medical treatments, resulting in patients delaying or forgoing necessary medical interventions (Alassoud et al., 2020; Giusti et al., 2024). This reliance on culturally informed lay knowledge can hinder effective management of heart failure, as patients may not fully understand the importance of adhering to prescribed treatments (Alassoud et al., 2020; Giusti et al., 2024).
Additionally, the cultural stigma surrounding chronic illnesses like heart failure can affect patients’ willingness to seek help or disclose their condition to healthcare providers (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018). In some cultures, there may be a perception that seeking medical help is a sign of weakness, leading individuals to avoid healthcare settings until their condition becomes critical (Alassoud et al., 2020; Giusti et al., 2024). This delay in seeking care can result in worse health outcomes, as patients may present with more advanced stages of heart failure that are more challenging to manage (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018).
Language barriers also play a crucial role in the cultural context of healthcare. Patients who do not speak the dominant language of the healthcare system may struggle to communicate their symptoms effectively, understand medical advice, or navigate the healthcare system (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018). This communication gap can lead to misunderstandings, misdiagnoses, and, ultimately, poorer health outcomes. Culturally competent care, which includes language support and culturally sensitive communication strategies, is essential for improving patient engagement and adherence to treatment plans (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018).
Furthermore, cultural beliefs about medication and treatment can influence adherence to prescribed regimens. For instance, some patients may hold beliefs that conflict with medical advice, such as the idea that drugs are unnecessary or harmful (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018). These beliefs can lead to non-adherence, a significant predictor of poor outcomes in heart failure management (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018). Addressing these cultural barriers requires healthcare providers to engage in open dialogues with patients, understand their cultural contexts, and tailor interventions accordingly (Alassoud et al., 2020; Giusti et al., 2024; Jongen et al., 2018).
Challenges and Barriers Concluding Thoughts
The challenges and barriers associated with heart failure are multifaceted, encompassing socioeconomic factors and cultural attitudes that significantly impact prevention and management. Addressing these issues requires a comprehensive approach that includes policy interventions to improve access to care, educational initiatives to enhance health literacy, and culturally competent healthcare practices to foster better patient-provider relationships. By understanding and addressing these challenges, healthcare systems can improve outcomes for heart failure patients and reduce the burden of this chronic condition on individuals and society as a whole.
Future Directions
Heart failure (HF) represents a significant public health challenge, with increasing prevalence and associated morbidity and mortality. As the understanding of heart failure evolves, it becomes essential to identify research gaps and policy implications that can guide future directions in this field. This synthesis will explore the current research gaps in heart failure, particularly focusing on the impact of emerging therapies and technologies on diverse populations, as well as the policy implications that can enhance heart failure prevention and management across various demographics.
Research Gaps
One of the critical research gaps in heart failure is the need for more comprehensive studies examining emerging therapies’ impact on diverse populations. For instance, while recent advancements in pharmacological treatments, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors, have shown promise in reducing heart failure hospitalizations, there is a lack of data on their effectiveness across different ethnic and socioeconomic groups (Rosano et al., 2020). This is particularly important as heart failure disproportionately affects marginalized populations, and understanding the differential impacts of these therapies can lead to more tailored and effective treatment strategies.
Moreover, integrating technology in heart failure management, such as telehealth and mobile health applications, presents another area requiring further investigation. Studies have indicated that heart failure patients express interest in using mobile health apps for self-care, yet the actual implementation and effectiveness of these technologies in improving patient outcomes remain underexplored (Sohn et al., 2019; Sohn et al., 2024). Research should focus on optimizing these technologies for diverse populations, considering factors such as health literacy and access to technology.
Additionally, the role of comorbidities in heart failure outcomes is an area that warrants further research. Conditions such as chronic obstructive pulmonary disease (COPD) and diabetes significantly impact heart failure prognosis, yet the interplay between these comorbidities and heart failure management strategies is not fully understood (Kaszuba et al., 2018; Kim et al., 2019). Future studies should aim to elucidate how these comorbidities affect treatment outcomes and the overall quality of life for heart failure patients.
Another critical gap is the need for longitudinal studies that assess the long-term effects of new heart failure therapies and interventions. While many clinical trials focus on short-term outcomes, understanding the long-term implications of treatments, particularly in older adults who are at higher risk for heart failure, is essential for developing effective management strategies (Forsyth et al., 2024; Rochmawati & Amalia, 2021).
Finally, there is a pressing need for research that addresses the psychological aspects of heart failure, including the prevalence of anxiety and depression among patients. These mental health conditions can significantly affect treatment adherence and overall health outcomes, yet they are often overlooked in clinical practice (Niaz et al., 2021; Darki et al., 2022). Investigating the psychological needs of heart failure patients and integrating mental health support into standard care could improve patient outcomes and quality of life.
Policy Implications
The increasing burden of heart failure necessitates robust healthcare policies aimed at improving prevention and management strategies across demographics. One key recommendation is the establishment of comprehensive heart failure management programs that incorporate multidisciplinary care teams. Such teams, which include cardiologists, pharmacists, dietitians, and mental health professionals, can provide holistic care that addresses the multifaceted needs of heart failure patients (Mills et al., 2019; Martyn et al., 2022). Policies should incentivize healthcare systems to adopt these models, ensuring patients receive coordinated care that improves outcomes.
Furthermore, policies should enhance access to emerging therapies and technologies for underserved populations. This includes ensuring equitable access to SGLT2 inhibitors and other novel treatments, as well as telehealth services that can bridge gaps in care for patients in rural or low-income areas (Nolan et al., 2022; Handoko & Bovenkamp, 2019). Policymakers should advocate for funding and resources that support implementing these technologies in diverse communities, thereby reducing health disparities in heart failure management.
Education and training for healthcare providers are also critical components of effective heart failure management policies. Providers must be equipped with the knowledge and skills to recognize and treat heart failure effectively, particularly in populations with unique needs, such as older people or those with multiple comorbidities (Saku et al., 2022). Policies should mandate ongoing education and training programs emphasizing the latest evidence-based practices in heart failure care.
Additionally, public health initiatives are essential to raise awareness about heart failure risk factors and prevention strategies. Campaigns that educate the public about the importance of managing conditions such as hypertension and diabetes, which are significant contributors to heart failure, can help reduce the incidence of this condition (Maeda et al., 2023; Moiz et al., 2019). Policymakers should collaborate with community organizations to develop targeted outreach programs that address the specific needs of at-risk populations.
Lastly, research funding should prioritize studies that address the identified gaps in heart failure research, particularly those focusing on diverse populations and the long-term effects of emerging therapies. By investing in research that explores the complexities of heart failure across different demographics, policymakers can facilitate the development of more effective and inclusive treatment strategies (Du et al., 2018; Bowen et al., 2020).
Future Directions Final Thoughts
Addressing the research gaps and policy implications surrounding heart failure is crucial for improving patient outcomes and quality of life. By focusing on the impact of emerging therapies and technologies on diverse populations, as well as implementing comprehensive healthcare policies, the management of heart failure can be significantly enhanced. Future research should aim to fill the identified gaps, ensuring that all patients receive equitable and effective care in the face of this growing public health challenge.
Conclusion
The research presented in this paper underscores the multifaceted nature of heart failure (HF) as a significant public health challenge, characterized by its complex etiology, diverse demographic impacts, and the necessity for comprehensive management strategies. Key findings reveal that heart failure affects approximately 26 million individuals globally, with its prevalence exacerbated by risk factors such as hypertension, diabetes, and obesity. The study highlights the critical role of both pharmacological and non-pharmacological interventions, including lifestyle modifications and innovative medical devices like cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM) therapy, in improving patient outcomes.
Moreover, the research emphasizes the importance of understanding demographic variations in heart failure prevalence and management. Factors such as age, gender, ethnicity, and socioeconomic status significantly influence the presentation of heart failure and the effectiveness of treatment strategies. For instance, older adults often experience atypical symptoms and a higher burden of comorbidities, while women are more likely to develop heart failure with preserved ejection fraction (HFpEF). Additionally, disparities in access to care and treatment adherence among different racial and ethnic groups highlight the need for culturally competent healthcare practices.
In light of these findings, there is a pressing need for tailored approaches to heart failure prevention and management, considering the diverse needs of various demographic groups. Healthcare providers and policymakers must prioritize developing comprehensive heart failure management programs that incorporate multidisciplinary care teams and address social determinants of health. Furthermore, public health initiatives should focus on raising awareness about heart failure risk factors and prevention strategies, particularly in underserved populations.
Ultimately, addressing the complexities of heart failure through personalized and culturally sensitive interventions will be essential in improving health outcomes and reducing the burden of this chronic condition on individuals and healthcare systems alike. Future research should continue to explore innovative therapies and their impacts across diverse populations, ensuring that all patients receive equitable and effective care in the face of this growing public health challenge.
In the grand tapestry of public health, heart failure emerges not merely as a medical condition but as a profound narrative woven with threads of individual stories, societal challenges, and the relentless pursuit of betterment. As we stand at the crossroads of innovation and compassion, embracing a holistic vision that transcends traditional boundaries is imperative, fostering a healthcare landscape where every heartbeat is valued and every voice is heard. By championing personalized care and dismantling barriers to access, we can illuminate the path toward a future where heart failure is not a sentence but a chapter in a larger story of resilience and hope. Let us commit to this journey, for in our collective efforts lies the power to transform lives and redefine the very essence of health and well-being.
References
Ahmad, F., Ning, H., Rich, J., Yancy, C., Lloyd‐Jones, D., & Wilkins, J. (2016). Hypertension, obesity, diabetes, and heart failure–free survival. JACC Heart Failure, 4(12), 911-919. https://doi.org/10.1016/j.jchf.2016.08.001
Akintoye, E., Álvarez, P., Salih, M., Sellke, F., & Briasoulis, Α. (2022). Outcomes of diabetic patients with end‐stage heart failure listed for heart transplantation: A propensity‐matched analysis. Clinical Transplantation, 36(4). https://doi.org/10.1111/ctr.14590
Al‐Ghamdi, B., Shafquat, A., & Mallawi, Y. (2017). Cardiac contractility modulation therapy: are there superresponders? Heartrhythm Case Reports, 3(4), 229-232. https://doi.org/10.1016/j.hrcr.2017.02.004
Alemayehu, K., Bekele, Y., & Habte, T. (2022). Factors associated with depression among heart failure patients at selected public hospitals in Addis Ababa, Ethiopia: A cross-sectional study. Plos Global Public Health, 2(8), e0000853. https://doi.org/10.1371/journal.pgph.0000853
Alassoud, B., Johnston, B., & Hogg, K. (2020). Culture and the understanding of advanced heart failure: a mixed-methods systematic review. Collegian Journal of the Royal College of Nursing Australia, 27(4), 459-470. https://doi.org/10.1016/j.colegn.2020.02.008
Arvanitis, M., Zhang, Y., Wang, W., Auton, A., Keramati, A., Chi, N. C., Ren, B., Post, W. S., & Battle, A. (2019). Genome-Wide Association and Multi-Omic Analyses Reveal New Mechanisms for Heart Failure. https://doi.org/10.1101/19006510
Avery, C. L., Loehr, L. R., Baggett, C., Chang, P. P., Kucharska-Newton, A. M., Matsushita, K., Rosamond, W. D., & Heiss, G. (2012). The population burden of heart failure attributable to modifiable risk factors. Journal of the American College of Cardiology, 60(17), 1640–1646. https://doi.org/10.1016/j.jacc.2012.07.022
Bain, A. (2018). Beta-blocker use in cardiovascular disease. British Journal of Cardiac Nursing, 13(10), 491-497. https://doi.org/10.12968/bjca.2018.13.10.491
Blinova, K., Pierson, J., & Narkar, A. (2023). Comprehensive collection of current methods for contractility and electrophysiology recordings in human cardiac cells. Journal of Visualized Experiments, (193). https://doi.org/10.3791/64988
Boffa, U., McGrady, M., Reid, C. M., Shiel, L., Wolfe, R., Liew, D., Campbell, D. J., Stewart, S., & Krum, H. (2017). Screening evaluation of the evolution of New Heart Failure Study (screen-HF): Early detection of chronic heart failure in the Workplace. Australian Health Review, 41(2), 121. https://doi.org/10.1071/ah15107
Bowen, R., Graetz, T., Emmert, D., & Avidan, M. (2020). Statistics of heart failure and mechanical circulatory support in 2020. Annals of Translational Medicine, 8(13), 827-827. https://doi.org/10.21037/atm-20-1127
Bozkurt, B., Ahmad, T., Alexander, K. M., Baker, W. L., Bosak, K., Breathett, K., Fonarow, G. C., Heidenreich, P., Ho, J. E., Hsich, E., Ibrahim, N. E., Jones, L. M., Khan, S. S., Khazanie, P., Koelling, T., Krumholz, H. M., Khush, K. K., Lee, C., Morris, A. A., … Ziaeian, B. (2023). Heart failure epidemiology and outcomes statistics: A report of the heart failure society of America. Journal of Cardiac Failure, 29(10), 1412–1451. https://doi.org/10.1016/j.cardfail.2023.07.006
Brooksbank, J., & Albert, C. (2023). Device-based therapies for decompensated heart failure. Current Opinion in Cardiology. https://doi.org/10.1097/hco.0000000000001026
Campbell, P., Krim, S., & Ventura, H. (2015). The bi-directional impact of two chronic illnesses: Heart failure and diabetes—a review of the epidemiology and outcomes. Cardiac Failure Review, 1(1), 8. https://doi.org/10.15420/cfr.2015.01.01.8
Cardiovascular Institute of the South. (2024, March 14). Congestive heart failure: Types & stages: CIS. Cardiovascular Institute of the South. https://www.cardio.com/blog/congestive-heart-failure-types-stages/
Chaturvedi, P., Kalani, A., Familtseva, A., Kamat, P., Metreveli, N., & Tyagi, S. (2015). Cardiac tissue inhibitor of matrix metalloprotease 4 dictates cardiomyocyte contractility and differentiation of embryonic stem cells into cardiomyocytes: Road to therapy. International Journal of Cardiology, 184, 350-363. https://doi.org/10.1016/j.ijcard.2015.01.091
Chruscinski, A., Huang, F. Y., Nguyen, A., Lioe, J., Tumiati, L. C., Kozuszko, S., Tinckam, K. J., Rao, V., Dunn, S. E., Persinger, M. A., Levy, G. A., & Ross, H. J. (2016). Generation of antigen microarrays to screen for autoantibodies in heart failure and heart transplantation. PLOS ONE, 11(3). https://doi.org/10.1371/journal.pone.0151224 https://doi.org/10.1371/journal.pone.0151224
Coats, A. (2019). Ageing, demographics, and heart failure. European Heart Journal Supplements, 21(Supplement_L), L4-L7. https://doi.org/10.1093/eurheartj/suz235
Cooper, L. B., Hammill, B. G., Sharma, P. P., DeVore, A. D., Mentz, R. J., Fonarow, G. C., Pang, P. S., Curtis, L. H., & Hernandez, A. F. (2015). Differences in health care use and outcomes by the timing of in-hospital worsening heart failure. American Heart Journal, 170(6), 1124–1132. https://doi.org/10.1016/j.ahj.2015.09.001
Cosentino, E. R., Degli Esposti, D., Miceli, R., Bentivenga, C., Landolfo, M., Ricci Iamino, I., Spinardi, L., Magri, G., & Borghi, C. (2018). Coexisting heart failure and chronic obstructive pulmonary disease: Report of two cases treated with indacaterol/glycopyrronium. Respiration, 95(Suppl. 1), 3–5. https://doi.org/10.1159/000487169
Dahy, A., Al-Jedda, W., & Al-Sharifi, A. (2020). Assessment of galectin-3, cystatin-c and n-terminal b-type natriuretic peptide of serum levels in patients with heart failure. ATMPH, 23(11). https://doi.org/10.36295/asro.2020.231120
Darki, C., Riley, J., Dadabhoy, D., Darki, A., & Garetto, J. (2022). The effect of classical music on heart rate, blood pressure, and mood. Cureus. https://doi.org/10.7759/cureus.27348
Das, U., Paul, A., & Banerjee, S. (2021). Sglt2 inhibitors in heart failure with reduced ejection fraction. The Egyptian Heart Journal, 73(1).https://doi.org/10.1186/s43044-021-00218-w
DeVore, A. D., Granger, B. B., Fonarow, G. C., Al-Khalidi, H. R., Albert, N. M., Lewis, E. F., Butler, J., Piña, I. L., Allen, L. A., Yancy, C. W., Cooper, L. B., Felker, G. M., Kaltenbach, L. A., McRae, A. T., Lanfear, D. E., Harrison, R. W., Disch, M., Ariely, D., Miller, J. M., … Hernandez, A. F. (2021). Effect of a hospital and postdischarge quality improvement intervention on clinical outcomes and quality of care for patients with heart failure with reduced ejection fraction. JAMA, 326(4), 314. https://doi.org/10.1001/jama.2021.8844
Dhanorkar, S., & Rajabhau, V. (2020). Untitled. Medpulse International Journal of Medicine, 13(1). https://doi.org/10.26611/1021131
Diaconu, C. (2019). Statins and heart failure. Archives of the Balkan Medical Union, 54(3), 401-403. https://doi.org/10.31688/abmu.2019.54.3.401
Du, X., Khamitova, A., Kyhlstedt, M., Sun, S., & Sengoelge, M. (2018). Utilisation of real-world data from heart failure registries in OECD countries - a systematic review. IJC Heart & Vasculature, 19, 90-97. https://doi.org/10.1016/j.ijcha.2018.02.006
Dulai, R., Chilmeran, A., Hassan, M., Veasey, R. A., Furniss, S., Patel, N. R., & Sulke, N. (2020). How many patients with heart failure are eligible for cardiac contractility modulation therapy? International Journal of Clinical Practice, 75(1). https://doi.org/10.1111/ijcp.13646
Dvornikov, A., Dewan, S., Alekhina, O., Pickett, F., & Tombe, P. (2014). Novel approaches to determine contractile function of the isolated adult zebrafish ventricular cardiac myocyte. The Journal of Physiology, 592(9), 1949-1956. https://doi.org/10.1113/jphysiol.2014.270678
Entezari‐Maleki, T. (2023). Global variations in heart failure. JAMA, 330(12), 1191. https://doi.org/10.1001/jama.2023.13773
Fang, L., Ma, Y., Wu, Y., Ge, Y., Liang, X., & Tang, R. (2024). Use of cardiac contractility modulation combined with left bundle branch pacing crt‐p in a female with a 22‐year history of non‐ischemic dilated cardiomyopathy: A case report. Echocardiography, 41(3). https://doi.org/10.1111/echo.15762
Feaster, T., Casciola, M., Narkar, A., & Blinova, K. (2021). Acute effects of cardiac contractility modulation on human induced pluripotent stem cell–derived cardiomyocytes. Physiological Reports, 9(21). https://doi.org/10.14814/phy2.15085
Ferreira, S. M., & Pêgo-Fernandes, P. M. (2022). Long-term mechanical assisted circulation devices. Sao Paulo Medical Journal, 140(3), 329–330. https://doi.org/10.1590/1516-3180.2022.140303122021
Forsyth, P., Young, S., Hughes, K., James, R., Oxley, C., Kelly, R., Jones, R., Briggs, S., Mackay-Thomas, L., Millerick, Y., Simpson, M., Taylor, C. J., Beggs, S., Piper, S., & Duckett, S. (2024). Multiprofessional heart failure self-development framework. Open Heart, 11(1). https://doi.org/10.1136/openhrt-2023-002554
Gallo, G., & Savoia, C. (2024). Hypertension and heart failure: From pathophysiology to treatment. International Journal of Molecular Sciences, 25(12), 6661. https://doi.org/10.3390/ijms25126661
Giusti, A., Pukrittayakamee, P., Wannarit, K., Thongchot, L., Janwanishstaporn, S., Nkhoma, K., Venkatapuram, S., & Harding, R. (2024). How to Deliver Person-Centred Care for People Living with Heart Failure: A Multi Stakeholder Interview Study with Patients, Caregivers and Healthcare Professionals in Thailand . https://doi.org/10.21203/rs.3.rs-4937518/v1
Givertz, M., Yang, M., Hess, G., Zhao, B., Rai, A., & Butler, J. (2021). Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event. ESC Heart Failure, 8(3), 1915-1923. https://doi.org/10.1002/ehf2.13155
Gohar, A., Kievit, R. F., Valstar, G. B., Hoes, A. W., Van Riet, E. E., van Mourik, Y., Bertens, L. C., Boonman-Winter, L. J., Bots, M. L., Den Ruijter, H. M., & Rutten, F. H. (2019). Opportunistic screening models for high-risk men and women to detect diastolic dysfunction and heart failure with preserved ejection fraction in the community. European Journal of Preventive Cardiology, 26(6), 613–623. https://doi.org/10.1177/2047487318816774
Griffith, B. (2023, March 27). Understanding cardiovascular disease risks for first responders. Police1. https://www.police1.com/wellness-week/articles/understanding-cardiovascular-disease-risks-for-first-responders-caI5XRdHnEU7QgLu/
Guo, Y., Zhang, Y., & Liu, W. (2022). The causal relationship between allergic diseases and heart failure: evidence from Mendelian randomization study. Plos One, 17(7), e0271985. https://doi.org/10.1371/journal.pone.0271985
Haizhu, Z., Cui, C., & Hu, D. (2010). Effects of electric stimulations applied during absolute refractory period on cardiac function of rabbits with heart failure. Journal of Huazhong University of Science and Technology [Medical Sciences], 30(2), 155-158. https://doi.org/10.1007/s11596-010-0204-3
Handoko, M., & Bovenkamp, A. (2019). Cardiomems: The next revolution in heart failure management? Netherlands Heart Journal, 28(1), 14-15. https://doi.org/10.1007/s12471-019-01356-2
He, Y., Dong, Z., Gu, X., Xu, J., & Li, X. (2024). Heart Failure Recurrence Prevention: Patient Knowledge, Attitudes, and Practices in Yancheng City. https://doi.org/10.21203/rs.3.rs-4674877/v1
He, X., Zhao, J., He, J., Dong, Y., & Liu, C. (2019). Association of household secondhand smoke exposure and mortality risk in patients with heart failure. BMC Cardiovascular Disorders, 19(1). https://doi.org/10.1186/s12872-019-1269-y
Herold, R., Hoffmann, W., & Berg, N. (2018). Telemedical monitoring of patients with chronic heart failure has a positive effect on total health costs. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3070-5
Hesselson, A. (2022). Cardiac contractility modulation: a technical review. Journal of Innovations in Cardiac Rhythm Management, 13(10), 5205-5218. https://doi.org/10.19102/icrm.2022.13102
Hoang, C., Đăng, T., Nguyen, N., & To, K. (2023). Knowledge, treatment adherence, and quality of life of heart failure patients at Nhan Dan Gia Dinh Hospital. Medpharmres, 7(4), 102-110. https://doi.org/10.32895/ump.mpr.7.4.13
Houck, P., Dandapantula, H., Hardegree, E., & Massey, J. (2020). Why we fail at heart failure: lymphatic insufficiency is disregarded. Cureus. https://doi.org/10.7759/cureus.8930
Hsu Chen, C., Chang, C.-Y., Yang, M.-C., Wu, J.-H., Liao, C.-H., Su, C.-P., Chen, Y.-C., Ho, S.-Y., Huang, C.-C., Lee, T.-H., Chen, W.-L., Chou, C.-C., & Lin, Y.-R. (2019). The impact of emergency interventions and patient characteristics on the risk of heart failure in patients with nontraumatic OHCA. Emergency Medicine International, 2019, 1–10. https://doi.org/10.1155/2019/6218389
Inoue, T., Maeda, Y., Sonoda, N., Sasaki, S., Kabemura, T., Kobayashi, K., & Inoguchi, T. (2016). Hyperinsulinemia and sulfonylurea use are independently associated with left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus with suboptimal blood glucose control. BMJ Open Diabetes Research & Care, 4(1). https://doi.org/10.1136/bmjdrc-2016-000223
Jain, M., Kiyawat, P., & Kiyawat, S. (2018). Heart failure with preserved ejection fraction: a study of clinical profile in Indian patients. International Journal of Contemporary Medical Research [IJCMR], 5(6). https://doi.org/10.21276/ijcmr.2018.5.6.25
Jeele, M., Hussein, A., Mohamud, M., Adani, A., & Mohamud, M. (2022). Spectrum and prevalence of renal dysfunction among heart failure patients attending at a tertiary care hospital: First report from Somalia. https://doi.org/10.21203/rs.3.rs-2217044/v1
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: A systematic scoping review. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3001-5
Kaszuba, E., Odeberg, H., Råstam, L., & Halling, A. (2018). Impact of heart failure and other comorbidities on mortality in patients with chronic obstructive pulmonary disease: a register-based, prospective cohort study. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0865-8
Khajehpoor, M., Shahrbabaki, P., & Nouhi, E. (2023). Effects of a home-based palliative heart failure program on quality of life among the elderly: A clinical trial study. BMC Palliative Care, 22(1). https://doi.org/10.1186/s12904-023-01245-x
Khatibzadeh, S., Farzadfar, F., Oliver, J., Ezzati, M., & Moran, A. (2013). Worldwide risk factors for heart failure: a systematic review and pooled analysis. International Journal of Cardiology, 168(2), 1186-1194. https://doi.org/10.1016/j.ijcard.2012.11.065
Klaiman, T., Iannotte, L. G., Josephs, M., Russell, L. B., Norton, L., Mehta, S., Troxel, A., Zhu, J., Volpp, K., & Asch, D. A. (2023). Qualitative analysis of a remote monitoring intervention for managing heart failure. BMC Cardiovascular Disorders, 23(1). https://doi.org/10.1186/s12872-023-03456-9
Kim, H. ‐L., Kim, M. ‐A., Park, K. ‐T., Choi, D. ‐J., Han, S., Jeon, E. ‐S., Cho, M. ‐C., Kim, J. ‐J., Yoo, B. ‐S., Shin, M. ‐S., Kang, S. ‐M., Chae, S. C., & Ryu, K. ‐H. (2019). Gender difference in the impact of coexisting diabetes mellitus on long‐term clinical outcome in people with heart failure: A report from the Korean Heart Failure Registry. Diabetic Medicine, 36(10), 1312–1318. https://doi.org/10.1111/dme.14059
Koike, M., Silva, V., Romanek, F., & Shirassu, M. (2016). Relationship of comorbidities and heart failure mortality in the city of São Paulo, Brazil. Medical Express, 3(2). https://doi.org/10.5935/medicalexpress.2016.02.05
Kokubo, T., Kodera, S., Sawano, S., Katsushika, S., Nakamoto, M., Takeuchi, H., Kimura, N., Shinohara, H., Matsuoka, R., Nakanishi, K., Nakao, T., Higashikuni, Y., Takeda, N., Fujiu, K., Daimon, M., Akazawa, H., Morita, H., Matsuyama, Y., & Komuro, I. (2022). Automatic detection of left ventricular dilatation and hypertrophy from electrocardiograms using Deep Learning. International Heart Journal, 63(5), 939–947. https://doi.org/10.1536/ihj.22-132
Koppikar, S., Colaco, K., Harvey, P., Akhtari, S., Chandran, V., Gladman, D. D., Cook, R., & Eder, L. (2022). Incidence of and risk factors for heart failure in patients with psoriatic disease: A cohort study. Arthritis Care & Research, 74(8), 1244–1253. https://doi.org/10.1002/acr.24578
LaRocca, T. J., Schwarzkopf, M., Altman, P., Zhang, S., Gupta, A., Gomes, I., Alvin, Z., Champion, H. C., Haddad, G., Hajjar, R. J., Devi, L. A., Schecter, A. D., & Tarzami, S. T. (2010). Β2-adrenergic receptor signaling in the cardiac myocyte is modulated by interactions with CXCR4. Journal of Cardiovascular Pharmacology, 56(5), 548–559. https://doi.org/10.1097/fjc.0b013e3181f713fe
Leff, J. D., & Shore-Lesserson, L. (2010). Left ventricular assist devices: An evolving state of the art. Seminars in Cardiothoracic and Vascular Anesthesia, 14(1), 21–23. https://doi.org/10.1177/1089253210362270
Lerman, B., Popat, R., Assimes, T., Heidenreich, P., & Wren, S. (2019). Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure. JAMA, 321(6), 572. https://doi.org/10.1001/jama.2019.0156
Li, M. (2024). Machine learning-based risk factor analysis in the prognosis of heart failure. Theoretical and Natural Science, 50(1), 128-133. https://doi.org/10.54254/2753-8818/50/2024au0142
Liu, C., Kawana, M., Song, D., Ruppel, K. M., & Spudich, J. A. (2018). Controlling Load-Dependent Contractility of the Heart at the Single Molecule Level. https://doi.org/10.1101/258020
Loaiza, R., Fattahi, F., Kalbitz, M., Grailer, J. J., Russell, M. W., Jalife, J., Valdivia, H. H., Zetoune, F. S., & Ward, P. A. (2024). The impact of extracellular histones and absence of toll-like receptors on cardiac functional and electrical disturbances in Mouse Hearts. International Journal of Molecular Sciences, 25(16), 8653. https://doi.org/10.3390/ijms25168653
Maeda, D., Dotare, T., Matsue, Y., Teramoto, K., Sunayama, T., Tromp, J., & Minamino, T. (2023). Blood pressure in heart failure management and prevention. Hypertension Research, 46(4), 817–833. https://doi.org/10.1038/s41440-022-01158-x
Mando, R., Goel, A., Habash, F., Saad, M., Ayoub, K., Vallurupalli, S., & Maskoun, W. (2019). Outcomes of cardiac contractility modulation: A systematic review and meta-analysis of randomized clinical trials. Cardiovascular Therapeutics, 2019, 1–10. https://doi.org/10.1155/2019/9769724
Manganelli, G., Fiorentino, A., Ceravolo, G., Minichiello, S., Bianchino, G., Bellizzi, G., Pacileo, G., & Masarone, D. (2021). Use of cardiac contractility modulation in an older patient with non-ischemic dilated cardiomyopathy: A case report. Clinics and Practice, 11(4), 835–840. https://doi.org/10.3390/clinpract11040098
Marinescu, M. (2023). “The use of brain natriuretic peptide in the evaluation of heart failure in geriatric patients.” Biomedical Journal of Scientific & Technical Research, 47(5). https://doi.org/10.26717/bjstr.2022.47.007576
Marinescu, M., Oprea, V., Nechita, A., Tutunaru, D., Nechita, L., & Romila, A. (2023). The use of brain natriuretic peptide in the evaluation of heart failure in geriatric patients. Diagnostics, 13(9), 1512. https://doi.org/10.3390/diagnostics13091512
Martyn, T., Montgomery, R., & Estep, J. (2022). The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health. Current Opinion in Cardiology, 37(3), 302-306. https://doi.org/10.1097/hco.0000000000000968
Masarone, D., Kittleson, M. M., De Vivo, S., D’Onofrio, A., Rao, I., Ammendola, E., Errigo, V., Martucci, M. L., Nigro, G., & Pacileo, G. (2022). Effects of cardiac contractility modulation electrodes on tricuspid regurgitation in patients with heart failure with reduced ejection fraction: A pilot study. Journal of Clinical Medicine, 11(24), 7442. https://doi.org/10.3390/jcm11247442
Masarone, D., Petraio, A., Fiorentino, A., Dellegrottaglie, S., Valente, F., Ammendola, E., Nigro, G., & Pacileo, G. (2022). Use of cardiac contractility modulation as bridge to transplant in an obese patient with advanced heart failure: A case report. Frontiers in Cardiovascular Medicine, 9. https://doi.org/10.3389/fcvm.2022.833143
Matsuo, M. (2020). Impact of age-related diseases on pulmonary function tests in older Japanese adults: a cross-sectional pilot study. JMA Journal, 3(3), 251-257. https://doi.org/10.31662/jmaj.2019-0076
Matteucci, A., Bonacchi, G., Fazia, V., Stifano, G., & Sergi, D. (2022). Matching imaging and remodulation effects: benefits of cardiac contractility modulation shown by global longitudinal strain: a case report. Clinics and Practice, 12(1), 113-117. https://doi.org/10.3390/clinpract12010015
McClellan, M., Brown, N., Califf, R. M., & Warner, J. J. (2019). Call to action: Urgent challenges in cardiovascular disease: A presidential advisory from the American Heart Association. Circulation, 139(9). https://doi.org/10.1161/cir.0000000000000652
Medert, R., Jungmann, A., Hildebrand, S., Busch, M., Grimm, D., Flockerzi, V., Müller, O. J., Most, P., Schumacher, D., & Freichel, M. (2021). Development of an AAV9-rnai-mediated silencing strategy to abrogate TRPM4 expression in the adult heart. Pflügers Archiv - European Journal of Physiology, 473(3), 533–546. https://doi.org/10.1007/s00424-021-02521-6
Melle, J., Bot, M., Jonge, P., Boer, R., Veldhuisen, D., & Whooley, M. (2010). Diabetes, glycemic control, and new-onset heart failure in patients with stable coronary artery disease. Diabetes Care, 33(9), 2084-2089. https://doi.org/10.2337/dc10-0286
Meril Life. (2020, October 27). Cardiovascular disease - advances in the treatment. https://www.merillife.com/blog/in-the-news/top-advances-in-prevention-treatment-of-cardiovascular-disease
Meyer, S., van der Meer, P., van Deursen, V. M., Jaarsma, T., van Veldhuisen, D. J., van der Wal, M. H., Hillege, H. L., & Voors, A. A. (2013). Neurohormonal and clinical sex differences in heart failure. European Heart Journal, 34(32), 2538–2547. https://doi.org/10.1093/eurheartj/eht152
Mills, A., Rodeffer, K., & Quick, S. (2019). Impact of heart failure transitions of care program: a prospective study of heart failure education and patient satisfaction. Hospital Pharmacy, 56(4), 252-258. https://doi.org/10.1177/0018578719889020
Mizutani, T., Furusawa, K., Haga, H., & Kawabata, K. (2016). Heterogeneous filament network formation by myosin light chain isoforms effects on contractile energy output of single cardiomyocytes derived from human induced pluripotent stem cells. Regenerative Therapy, 3, 90-96. https://doi.org/10.1016/j.reth.2016.02.009
Mohapatra, A., & James, C. (2023). Rejuvenating a failing heart: A case report. Journal of Cardiology & Current Research, 16(3). https://doi.org/10.15406/jccr.16.3
Moiz, D., Azdee, H., Khawaja, D., Afnan, M., Muhammad, D., & Arshad, B. (2019). Hypertension as a predictor in-hospital mortality among patients having congestive heart failure. JMPB. https://doi.org/10.7176/jmpb/55-07
Mujib, M., Zhang, Y., Feller, M., & Ahmed, A. (2011). Evidence of a “heart failure belt” in the southeastern United States. The American Journal of Cardiology, 107(6), 935-937. https://doi.org/10.1016/j.amjcard.2010.11.012
Mun, J. Y., Previs, M. J., Yu, H. Y., Gulick, J., Tobacman, L. S., Beck Previs, S., Robbins, J., Warshaw, D. M., & Craig, R. (2014). Myosin-binding protein C displaces tropomyosin to activate cardiac thin filaments and governs their speed by an independent mechanism. Proceedings of the National Academy of Sciences, 111(6), 2170–2175. https://doi.org/10.1073/pnas.1316001111
Narducci, M. L., Nurchis, M. C., Ballacci, F., Giordano, F., Calabrò, G. E., Massetti, M., Crea, F., Aspromonte, N., & Damiani, G. (2023). Cost–utility of cardiac contractility modulation in patients with heart failure with reduced ejection fraction in Italy. ESC Heart Failure, 11(1), 229–239. https://doi.org/10.1002/ehf2.14538
Niaz, N., Ali, S., Younas, A., Faridi, T., & Hanif, A. (2021). Strong risk factors for depression and anxiety in heart failure patients. Pakistan Biomedical Journal. https://doi.org/10.52229/pbmj.v4i2.70
Nichols, R., Demers, L. A., Larsen, B. M., Robinson, D., Converso, K., Russell, M. W., & Westfall, M. V. (2010). Human rfamide-related peptide-1 diminishes cellular and integrated cardiac contractile performance. Peptides, 31(11), 2067–2074. https://doi.org/10.1016/j.peptides.2010.07.012
Ning, B., Qi, X., Li, Y., Liu, H., Zhang, F., & Chen, Q. (2014). Biventricular pacing cardiac contractility modulation improves cardiac contractile function via upregulating serca2 and mir-133 in a rabbit model of congestive heart failure. Cellular Physiology and Biochemistry, 33(5), 1389-1399. https://doi.org/10.1159/000358705
Nolan, M., Tan, N., & Neil, C. (2022). Novel non-pharmaceutical advancements in heart failure management: The emerging role of technology. Current Cardiology Reviews, 18(4). https://doi.org/10.2174/1573403x17666210831144141
Nundy, S., Razi, R. R., Dick, J. J., Smith, B., Mayo, A., O’Connor, A., & Meltzer, D. O. (2013). A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: Before-after study. Journal of Medical Internet Research, 15(3). https://doi.org/10.2196/jmir.2317
Nyaga, U., Bigna, J., Agbor, V., Essouma, M., Ntusi, N., & Noubiap, J. (2018). Data on the epidemiology of heart failure in sub-Saharan Africa. Data in Brief, 17, 1218-1239. https://doi.org/10.1016/j.dib.2018.01.100
Odeyemi, J., Akinade, O. N., Osabutey, A., Okorigba, E. M., Esomonye, T., Oboasekhi, A., & Ogedengbe, W. F. (2022). Obesity and heart failure: Understanding the paradox. International Journal Of Scientific Advances, 3(4). https://doi.org/10.51542/ijscia.v3i4.13
O’Donnell, C., Yancy, C., & McNally, E. (2018). Is heart failure inherited? JAMA Cardiology, 3(8), 710. https://doi.org/10.1001/jamacardio.2018.1918
Ogilvie, R., Everson‐Rose, S., Longstreth, W., Rodríguez, C., Diez‐Roux, A., & Lutsey, P. (2016). Psychosocial factors and risk of incident heart failure. Circulation Heart Failure, 9(1). https://doi.org/10.1161/circheartfailure.115.002243
Okello, E., Wanzhu, Z., Musoke, C., Twalib, A., Kakande, B., Lwabi, P., Wilson, N. B., Mondo, C. K., Odoi-Adome, R., & Freers, J. (2013). Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda : Cardiovascular topics. Cardiovascular Journal Of Africa, 24(3), 76–79. https://doi.org/10.5830/cvja-2013-004
Oliver, B., Travis, A., Hughes, E., Condrat, L., Ullman, J., Cohen, B., & Cartwright, F. (2022). Improved 30-Day heart failure readmissions following implementation of an advanced cardiovascular education (ACE) academy. Journal of Nursing Care Quality, 37(4), 300–306. https://doi.org/10.1097/ncq.0000000000000631
Owusu, I. (2013). Prevalence and aetiology of heart failure in patients seen at a teaching hospital in Ghana. Journal of Cardiovascular Diseases & Diagnosis, 01(05). https://doi.org/10.4172/2329-9517.1000131
Padi, T., Sakkeel, P., & Kanimozhi, V. (2022). Bivariate stochastic simultaneous differential equation model for heart failure. Asian Journal of Probability and Statistics, 33-40. https://doi.org/10.9734/ajpas/2022/v19i130461
Pardon, G., Vander Roest, A. S., Chirikian, O., Birnbaum, F., Lewis, H., Castillo, E. A., Wilson, R., Denisin, A. K., Blair, C. A., Holbrook, C., Koleckar, K., Chang, A. C., Blau, H. M., & Pruitt, B. L. (2024). Tracking single hipsc-derived cardiomyocyte contractile function using CONTRAX an efficient pipeline for traction force measurement. Nature Communications, 15(1). https://doi.org/10.1038/s41467-024-49755-3
Patel, K., Taneja, K., Mohamed, A., Batchu, S., Hsiung, H., Mott, C., Tornberg, H., & Patel, U. K. (2022). An analysis of epidemiological factors in heart failure outcomes. Cureus. https://doi.org/10.7759/cureus.22627
Poliakova, D. and Шарапова, О. (2024). Sex differences in the coronary system of the human heart. Актуальні Проблеми Сучасної Медицини Вісник Української Медичної Стоматологічної Академії, 24(2), 268-273. https://doi.org/10.31718/2077-1096.24.2.268
Ponikowski, P., Anker, S. D., AlHabib, K. F., Cowie, M. R., Force, T. L., Hu, S., Jaarsma, T., Krum, H., Rastogi, V., Rohde, L. E., Samal, U. C., Shimokawa, H., Budi Siswanto, B., Sliwa, K., & Filippatos, G. (2014). Heart failure: Preventing disease and death worldwide. ESC Heart Failure. https://doi.org/10.1002/2055-5822.12005
Rasouli, S., & Stainier, D. (2017). Regulation of cardiomyocyte behavior in zebrafish trabeculation by neuregulin 2a signaling. Nature Communications, 8(1). https://doi.org/10.1038/ncomms15281
Ray, A. (2024). Impending heart failure: An artificial intellectual reality. https://doi.org/10.1101/2024.08.12.24311907
Rochmawati, E., & Amalia, S. (2021). Self-care behavior and frailty syndrome among elderly patients with heart failure. Open Access Macedonian Journal of Medical Sciences, 9(T4), 231-235. https://doi.org/10.3889/oamjms.2021.5773
Rodeheffer, R. (2011). Hypertension and heart failure. Circulation, 124(17), 1803-1805. https://doi.org/10.1161/circulationaha.111.059303
Roland, J. (2024, December 4). Common medications for atrial fibrillation (AFIB). Healthline. https://www.healthline.com/health/living-with-atrial-fibrillation/medication-list
Roller, T., Heinke, M., & Hörth, J. (2018). Pacing electrode modeling and simulation of cardiac contractility modulation. Current Directions in Biomedical Engineering, 4(1), 551-554. https://doi.org/10.1515/cdbme-2018-1131
Rosano, G., Quek, D., & Martínez, F. (2020). Sodium–glucose cotransporter 2 inhibitors in heart failure: recent data and implications for practice. Cardiac Failure Review, 6. https://doi.org/10.15420/cfr.2020.23
Saku, K., Yokota, S., Nishikawa, T., & Kinugawa, K. (2022). Interventional heart failure therapy: a new concept fighting against heart failure. Journal of Cardiology, 80(2), 101-109. https://doi.org/10.1016/j.jjcc.2021.11.018
Sampson, M. (2022). Pharmacological management of chronic heart failure. Nursing Standard, 37(8), 55-61. https://doi.org/10.7748/ns.2022.e12004
Sano, M. (2020). A paradigm shift in the treatment of type 2 diabetes and heart failure. Journal of Atherosclerosis and Thrombosis, 27(8), 727-731. https://doi.org/10.5551/jat.rv17042
Sarhadi, Z., Jahantigh, M., & Yaghoubinia, F. (2024). Effect of self-efficacy-based training on treatment adherence of patients with heart failure. Medical - Surgical Nursing Journal, 12(3). https://doi.org/10.5812/msnj-146493
Sarkari, M., Yadav, M., & Kr., A. (2020). Etiological profile in patients with heart failure. International Journal of Research in Medical Sciences, 8(8), 2845. https://doi.org/10.18203/2320-6012.ijrms20203092
Sasaki, D., Matsuura, K., Seta, H., Haraguchi, Y., Okano, T., & Shimizu, T. (2018). Contractile force measurement of human induced pluripotent stem cell-derived cardiac cell sheet-tissue. Plos One, 13(5), e0198026. https://doi.org/10.1371/journal.pone.0198026
Satoh, S., Kamo, M., Ohtsuka, T., & Hiyamuta, K. (2015). Effects of exercise training on the hemodynamics in patients with chronic heart failure. Journal of Integrative Cardiology, 1(2). https://doi.org/10.15761/jic.1000113
Shen, F., Liu, Y., Jin, H., Chen, G., & Zhou, X. (2015). Enhancement of cardiac contractility by refractory period stimulation in conjunction with cardiac resynchronization therapy. Journal of Integrative Cardiology, 1(4). https://doi.org/10.15761/jic.1000125
Shettigar, V., Zhang, B., Little, S. C., Salhi, H. E., Hansen, B. J., Li, N., Zhang, J., Roof, S. R., Ho, H.-T., Brunello, L., Lerch, J. K., Weisleder, N., Fedorov, V. V., Accornero, F., Rafael-Fortney, J. A., Gyorke, S., Janssen, P. M., Biesiadecki, B. J., Ziolo, M. T., & Davis, J. P. (2016). Rationally engineered troponin C modulates in vivo cardiac function and performance in health and disease. Nature Communications, 7(1). https://doi.org/10.1038/ncomms10794
Smith, D. H., Johnson, E. S., Blough, D. K., Thorp, M. L., Yang, X., Petrik, A. F., & Crispell, K. A. (2012). Predicting costs of care in heart failure patients. BMC Health Services Research, 12(1). https://doi.org/10.1186/1472-6963-12-434
Snow, S., Fonarow, G., Ladapo, J., Washington, D., Hoggatt, K., & Ziaeian, B. (2019). National rate of tobacco and substance use disorders among hospitalized heart failure patients. The American Journal of Medicine, 132(4), 478-488.e4. https://doi.org/10.1016/j.amjmed.2018.11.038
Sohn, A., Speier, W., Lan, E., Aoki, K., Fonarow, G., Ong, M., & Arnold, C. (2019). Assessment of heart failure patients’ interest in mobile health apps for self-care: Survey study. JMIR Cardio, 3(2). https://doi.org/10.2196/14332
Sohn, A., Turner, A., Speier, W., Fonarow, G., Ong, M., & Arnold, C. (2024). Patients with heart failure: internet use and mobile health perceptions. Applied Clinical Informatics, 15(04), 709-716. https://doi.org/10.1055/a-2273-5278
Solomou, S., Stavrou, M., & Marley, J. (2016). Diagnosis of dilated cardiomyopathy: Patient reaction and adaptation—case study and review of the literature. Case Reports in Psychiatry, 2016, 1–6. https://doi.org/10.1155/2016/1756510
Son, Y., Choi, J., & Lee, H. (2020). Effectiveness of nurse-led heart failure self-care education on health outcomes of heart failure patients: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(18), 6559. https://doi.org/10.3390/ijerph17186559
Soto, L. (2019, March 17). New guidelines: Healthy lifestyle, managing risks are key to preventing heart attack, stroke. www.heart.org. https://www.heart.org/en/news/2019/03/17/new-guidelines-healthy-lifestyle-managing-risks-are-key-to-preventing-heart-attack-stroke
Soysaler, C., Andrei, C., Ceban, O., & Sinescu, C. (2023). The impact of comorbidities and demographic factors on ejection fraction. Medicines, 11(1), 1. https://doi.org/10.3390/medicines11010001
Stoica, A., Harpa, M., Hussein, H. A., Opriş, C., Opriş, C., Hussein, H. A., Ghiragosian, C., Banceu, C., & Suciu, H. (2020). Decompensated aortic stenosis in a young patient with multiple comorbidities - A case report. Acta Medica Transilvanica, 25(2), 39–41. https://doi.org/10.2478/amtsb-2020-0027
Tan, S., Tan, W., Zheng, L., & Kumar, S. (2023). Trends, outcomes, and healthcare disparities of Asian patients with heart failure and advanced chronic kidney disease. https://doi.org/10.1101/2023.10.09.23296780
Tanai, E., & Frantz, S. (2015). Pathophysiology of heart failure. Comprehensive Physiology, 187–214. https://doi.org/10.1002/cphy.c140055
Ted Rogers Centre for Heart Research. (2022, May 26). Preventing heart failure our heart hub. Our Heart Hub - Digital Innovation for Heart Failure Care. https://ourhearthub.ca/preventing-heart-failure/
Ţînţ, D., & Micu, S. (2022). One-year outcome of cardiac contractility modulation in patients with reduced ejection fraction, atrial fibrillation, and previous resynchronization: A pilot study. American Journal of Therapeutics, 30(1), e10-e16. https://doi.org/10.1097/mjt.0000000000001579
Ţînţ, D., Florea, R., & Micu, S. (2019). New generation cardiac contractility modulation device—filling the gap in heart failure treatment. Journal of Clinical Medicine, 8(5), 588. https://doi.org/10.3390/jcm8050588
Traister, A., Li, M., Aafaqi, S., Lu, M., Arab, S., Radisic, M., Gross, G., Guido, F., Sherret, J., Verma, S., Slorach, C., Mertens, L., Hui, W., Roy, A., Delgado-Olguín, P., Hannigan, G., Maynes, J. T., & Coles, J. G. (2014). Integrin-linked kinase mediates force transduction in cardiomyocytes by modulating serca2a/PLN function. Nature Communications, 5(1). https://doi.org/10.1038/ncomms5533
Tschöpe, C., Butler, J., Farmakis, D., Morley, D., Rao, I., & Filippatos, G. (2020). Clinical effects of cardiac contractility modulation in heart failure with mildly reduced systolic function. ESC Heart Failure, 7(6), 3531-3535. https://doi.org/10.1002/ehf2.13126
Uhl, S., Freichel, M., & Mathar, I. (2015). Contractility measurements on isolated papillary muscles for the investigation of cardiac inotropy in mice. Journal of Visualized Experiments, (103). https://doi.org/10.3791/53076
Ullah, A., Ayub, A., Shah, B., Ghaffarr, R., Khan, A., & Hussain, H. (2021). Health-related quality of life in systolic heart failure patients at tertiary care unit cardiology OPD Hayatabad Medical Complex Peshawar Pakistan. Pakistan Journal of Public Health, 10(3), 140-146. https://doi.org/10.32413/pjph.v10i3.501
Urien, J. M., Berthelot, E., Raphael, P., Moine, T., Lopes, M. E., Assayag, P., & Jourdain, P. (2024). Evaluation of a new telemedicine system for early detection of cardiac instability in patients with chronic heart failure: Real-life out-of-hospital study. JMIR Cardio, 8. https://doi.org/10.2196/52648
Verbrugge, F. H., Dupont, M., Vercammen, J., Jacobs, L., Verhaert, D., Vandervoort, P., Tang, W. H., & Mullens, W. (2012). Time from emerging heart failure symptoms to cardiac resynchronisation therapy: Impact on clinical response. Heart, 99(5), 314–319. https://doi.org/10.1136/heartjnl-2012-302807
Verma, S., Sharma, A., Kanumilli, N., & Butler, J. (2019). Predictors of heart failure development in type 2 diabetes. Current Opinion in Cardiology, 34(5), 578-583. https://doi.org/10.1097/hco.0000000000000647
Virginia Department of Health. Go to the Virginia Department of Health. (n.d.). https://www.vdh.virginia.gov/heart-disease/prevention/
Wadthaisong, M., Witayavanitkul, N., Bupha‐Intr, T., Wattanapermpool, J., & Tombe, P. (2019). Chronic high‐dose testosterone treatment: impact on rat cardiac contractile biology. Physiological Reports, 7(14). https://doi.org/10.14814/phy2.14192
Wang, H., Wang, L., Song, L., Zhang, Y.-W., Ye, J., Xu, R.-X., Shi, N., & Meng, X.-M. (2013). TNNI3K is a novel mediator of myofilament function and phosphorylates cardiac troponin I. Brazilian Journal of Medical and Biological Research, 46(2), 128–137. https://doi.org/10.1590/1414-431x20122515
White‐Williams, C., Bittner, V., Eagleson, R., Feltman, M., & Shirey, M. (2022). Interprofessional collaborative practice improves access to care and healthcare quality to advance health equity. Journal for Healthcare Quality, 44(5), 294-304. https://doi.org/10.1097/jhq.0000000000000353
Winter, J., Brack, K., & Ng, G. (2011). The acute inotropic effects of cardiac contractility modulation (CCM) are associated with action potential duration shortening and mediated by β1-adrenoceptor signalling. Journal of Molecular and Cellular Cardiology, 51(2), 252-262. https://doi.org/10.1016/j.yjmcc.2011.04.010
Wojtaszczyk, A., Kaczmarek, K., Ptaszynski, P., Wranicz, J., & Cygankiewicz, I. (2024). Dependence from Cardiac Contractility Modulation -- a Loss of Modulation as a Cause of Heart Failure Exacerbation. https://doi.org/10.22541/au.171289152.23092206/v1
Xiao-ming, Z., Xu, Y., & Zhang, J. (2024). Cardiometabolic index is associated with heart failure: A cross-sectional study based on NHANES. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1507100
Xiuzhen, L., Ji, R., Wang, X., Xin, R., & Chen, Q. (2022). A systematic review and meta-analysis of the effect of transitional care interventions on the prognosis of patients with heart failure. Journal of Thoracic Disease, 14(4), 1164-1171. https://doi.org/10.21037/jtd-22-102
Yang, Y. chi, Aung, T. T., & Wase, A. (2019). Inappropriate defibrillator shocks due to mechanical inference from an investigational device. Case Reports in Cardiology, 2019, 1–3. https://doi.org/10.1155/2019/2810396
Yelwanti, C., & Desai, V. (2016). A study on clinical and aetiological profile of heart failure at KBN Teaching and General Hospital. Journal of Evidence-Based Medicine and Healthcare, 3(83), 4509-4514. https://doi.org/10.18410/jebmh/2016/956
Younis, Y. (2015). Nurse’s knowledge about modifiable and non-modifiable risk factors of heart failure patient in Erbil teaching hospitals. Kufa Journal for Nursing Sciences, 4(3), 162-171. https://doi.org/10.36321/kjns.vi20143.2753
Zhang, H., Zhang, X., Wu, M., Lv, Y., Zhu, Z., Wei, N., Liu, B., Zhou, J., Zhang, W., Cui, Q., Liu, F., & Ma, M. (2023). Impact of Obesity on Heart Failure Risk Is Mediated by Hypertension: Univariable and Multivariable Mendelian Randomization Study. https://doi.org/10.21203/rs.3.rs-3308386/v1
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